April 8, 2021

Episode 52: How the pandemic changed Mercy’s approach to nurse staffing forever

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Description

The pandemic has upended many things in healthcare, one of which is the way we think about nurse staffing. Our guest for this episode is Betty Jo Rocchio, Senior Vice President & System Chief Nursing Officer for Mercy. 

Mercy has been in the midst of rolling out a new hub-based approach to their nursing workforce that allows them to more flexibly staff up and down with full-time and contingent nurses. During the pandemic, Mercy organized its workforce around regional pods and used a data-driven approach that allowed them to more easily move nurses through the system to meet the needs of different regions. 

Betty Jo details their process, how it will be used moving forward and how she thinks the pandemic has changed what nurses want from their jobs. 


Links to recommended reading: 

Podcast

Transcript

Dan:
Betty Jo, welcome to the show.

Betty Jo:
Hi Dan. Thank you for having me. I'm so excited to be here with you.

Dan:
So, we've been through a lot. 2020 is finally over. And as a nurse executive over a large system, what are you up to lately? I know vaccinations are coming out. What's top of mind for you right now?

Betty Jo:
Well, Dan, here in the Midwest where Mercy's hospitals are located, we are right now starting to make the switch between heading out of the pandemic and heading back into operations. Although the height of the pandemic is still here, we're still seeing some of our largest numbers, we believe with heading into the second round of our vaccinations and the community vaccination starting that now's the right time to start to get back to focusing on what the new normal is going to look like in operation. So we've been starting to head in that direction right now.

Dan:
I love that idea of evolving a system. I have to say I haven't seen it across the whole country. I think there's been many places that have devolved, went backwards, into practices of leadership and running systems that are not great.,And we saw that across many places. But I love that you're focused on the future and what the evolution is. What are some of the things that are top of mind for you as you evolve into this new 2021 world of post-pandemic healthcare?

Betty Jo:
While the pandemic, Dan, has been hard at the patient care front lines, I just want to make the qualification. You're going to hear me be a little bit positive about the pandemic. But just from a leadership standpoint and what it taught us, it has been very hard on the front lines. And they have been, it's been just the grind and grueling away trying to make sure that each of our patients are taken care of.

Betty Jo:
But I think what that's taught us is the pandemic has been a disruptor and it's made us start to think about, at the leadership level, what our nursing leadership framework needs to look like post-pandemic. Heading into the pandemic, I would say Mercy was very innovative. Our leadership framework in nursing needed a little bit of, kind of sprucing up, I would say. And so through the whole pandemic we tried to learn what has served us well, and maybe what we wished might've been in a little bit better shape.

Betty Jo:
And I think transforming our nursing framework is something that we've had a heavy focus on, and we're going to continue that work post. Most of nursing across the nation, Dan, has always had a strong framework in the nursing practice lane. But where we sometimes struggle is that nursing operational lane that causes us to focus on the building blocks that allow the practice to really thrive, rather than just exist. And in between those two lanes, the practice and the operations, is where I like to say the innovation begins. And it's really about how do we focus on the analytics, the technology, and our disruptors, they're going to cause us to be better for our patients.

Dan:
Yeah, that's a great point. And I think, I know that Mercy is really focused on data-driven leadership as well, or evidence-based leadership as I like to call it, which is amazing. What were some of the data points that you were able to use to stay kind of head above water through the whole crisis and where were some of the gaps that you felt there wasn't just enough data and you had to kind of make those innovative, in the moment, decisions?

Betty Jo:
That's a great question. So being from a health system that has a ton of data, and I would say was probably on the cutting edge of analytics, it taught us even to be better in those lanes. And so the things we had that were just foundational to allow us to move forward during the pandemic were the visibility around supply chain. And so, one of the key things, as you know, during the pandemic has been the use of personal protective equipment, the PPE. And what has been so key is having enough for our front lines to be able to take care of our patients.

Betty Jo:
And so we had great visibility into the datasets around N-95 masks, gowns, gloves. While other people were trying to figure out what their inventory levels were in a health system, we had that at our fingertips and allowed us to be able to go out and acquire exactly what we needed to reinforce before anybody else even had the assessment done. And so that was just a game changer for us because we were already ahead of the game with that PPE.

Betty Jo:
And so we were able to start focusing on the next level priority, which was how do we design care and capacity management for our patients while others were still focusing on the PBE. So it did give us a leg up and allowed us to continue to stay ahead during the pandemic. And so what we're focusing on in the second stage was that capacity management. And how do we serve the patient population that's coming in that has COVID as well as continue to serve our community around our surgical cases, our procedural cases, and just the regular medical attention, inpatient and outpatient, that our patients needed.

Betty Jo:
So we were able to accomplish that dual strategy probably faster than most, and we've never gone back. Once we initially shut down our elective type of care or surgeries, as well as some of our medical care, once we brought it back up in May, we've never had to shut it back off again. And it's been a huge bonus for our communities. And I'd say a testament to Mercy's investment in innovation and technology.

Dan:
That's amazing. And I'm interested, on the topic of leadership, how you supported your leaders, your frontline nursing leaders through all this. I mean, nurse managers, nurse directors have one of the hardest in all of healthcare, if not the hardest job. Sandwiched between competing demands, financial and business incentives and patient care. How did you support them with data, and even just emotionally and physically as this continued to go on?

Betty Jo:
Good point. I look at data as evidence-based practice. It might be different than doing, looking at the literature search, right? Or looking at things to be able to tell you on that practice lane, but data is the evidence-based care for that nursing operational way. And so when you have the data arranged for information, it allows your frontline managers to take that off of their plate of trying to redesign how they're going to deliver that care and put it in a data set that tells them where to go. So when you look at being descriptive, predictive, and then prescriptive, done in the right way we can give them the data set that tells them exactly what they need to do, when they need to do it, and allows that flex that had to occur during the pandemic.

Betty Jo:
As you know we saw surges of the pandemic that occurred, and it was no different in Mercy. There might be a region in the East that was surging with COVID and in the West region, we weren't surging at that point. And having designed what we call a hub structure for the workforce allowed us to flex and move our workforce around to help us be able to accomplish patient care in the areas that were surging. And so understanding of the total workforce pool took it off of the individual frontline manager, and took it, actually, off of the individual hospital. And allowed us to function in regional pods to move that workforce to accomplish better patient care and took it off the frontline manager.

Betty Jo:
That was huge during the pandemic because that's where most of the frontline managers were feeling the stress, was about a workforce shortage. And so taking that off of them allowed them to free up some time to focus more in that practice lane of helping our patients get better, quicker, faster. And give them the emotional support that they needed while we're giving the support to our managers that they needed. So it was a win-win in all areas.

Dan:
Yeah, I love that. And one of the things that I truly believe in, and it's backed up by research into just group think and systems, is in the absence of information, people will make it up. [crosstalk 00:08:25] And so if you don't arm people with the right information, they will fill in the gaps. Because human nature is you don't like to be in ambiguity very long. And so you find that that's how toxic work cultures start, that's how weird decision-making happens.

Dan:
So the more you can arm them with that data and those resources, the better decision-making, the more informed evidence-based decision making you'll have. So I love that that's part of it.

Dan:
And then the workforce piece, the systemness, right? The leveraging the entire system and not looking it as potentially service lines or this hospital's on an island over here, but looking at regions, or even the entire system, to see what resources can be moved more fluidly around, is awesome. And that was something that I'm really excited about. And if you look at complex systems and how high-performing systems works, that's exactly the characteristics they have. They're able to leverage the system connections rather than isolated things, so that's great.

Dan:
You did start going into the nurse staffing and workforce piece, and I'd love to dig into that a little bit more. You talked a little bit about how you were able to move staff around. What have you learned from this? I know, I mean, in our world it's travel nursing and temporary labor. I know you guys have a ton of data around internal associates and how you move things around. What have you learned over the past few months about workforce and what do you never going back to?

Betty Jo:
Hmm. That is the hundred million dollar question, right? So the reason I really enjoyed a piece of the pandemic was it highlighted the problems that we knew were underneath the surface for so long, Dan. We have known for 10 plus years that workforce is a huge issue. This brought it to light so fast and so quick that there was no hiding or having a strategy that partially fulfilled where you needed to go because you weren't going to get there fast enough. And so what we've learned is what I believe the frontline nurse has been screaming at us for years. They want flexibility. They want to be able to work when they want to work. And they want to show up and be able to do the very best job possible when they want to show up.

Betty Jo:
And what they did during the pandemic was they moved towards that model. They showed us, if we are paying attention, what innovative workforce looks like post-pandemic. And in my brain, the way I interpreted it, was that we're going to have to build in flexibility into the workforce. They're not going to settle back down and take the status quo. They are not going to go back into jobs where they're making the same amount of money they were necessarily doing the same work. Doing the same 12 hour shifts that they asked us for 10 years ago, but they're not asking us for that today.

Betty Jo:
And so we're going to have to figure out a way to make that innovative and that workforce, and still allow those people that want to settle back into that, to settle back into that, as well as provide all the flexibility around money, time and practice that we possibly can. That's where I'm focusing, is reorganizing, in Mercy, how are we going to accomplish that, Dan, right? That's the true innovation.

Dan:
Yeah, yeah. 100%, I think. The world, and this is something that we say a lot, is you'll never, ever be fully staffed again in the traditional way.

Betty Jo:
That's right.

Dan:
So you have to think about flexible work, non-traditional roles. I mean, I had a dream once that all nurses were salaried and we took on patient populations like our physician partners do. Maybe we'll get there at some point. But I think we need to continue to think about disruptive models to the workforce. I think this shift-based service line, you're a med-surg nurse forever kind of idea, is not where the profession is going or needs to go. And so I'm excited that you're experimenting with some of that.

Betty Jo:
I'm not saying there's not going to be some failure in there with any true innovation. But I think even that'll teach us something, right?

Dan:
Yeah.

Betty Jo:
If you're not afraid to fail, you certainly can put winning on your plate at some point.

Dan:
Yeah. No, that's great. What advice do you have for some nurse leaders that may be considering kind of disrupting their own ideas around workforce? What are some tips and tricks that you might have for them to start that process?

Betty Jo:
It always starts out with what are you trying to accomplish and what's the vision? And so we've been heading towards trying to be fully staffed, and you said it best. We will probably never be fully staffed again. But staffed is the key in this. It's not about staffing to a level, it's about staffing to what you need for the shift. And that becomes very different.

Betty Jo:
And when you look at learning the lesson and what that actually means through the nursing lens, it's about looking outside of healthcare and looking at the innovative things that have happened around us that are more on demand. And what comes to my mind is the Uber and Lyft concept of demanding, right, to get a ride somewhere. It's the same concept. It's the same math in the background, Dan. And it's about taking a look at... When you pull up an app on your phone, you never wait longer, usually, than five to 10 minutes to get a ride somewhere?

Betty Jo:
How does that happen in the background? It's a math problem. So staffing doesn't always have to begin with scheduling. But in our nursing brains we follow the schedule, follows the staff, follows how we schedule people to take care of patients on that day. Why does it have to look like that? When innovative strategies out in the marketplace outside of healthcare have done it better, faster, quicker, let's try to take those models and apply it to nurse staffing in the moment.

Betty Jo:
And I think the closer you get towards where your patient census is for the day, the better you can staff. But we try to predict it out six weeks, based off of historical models that may or may not hold true. So we may be wrong six to eight weeks out. And we just continue that wrong thinking right into day of staffing, which translates into a headache for the frontline manager, which leaves them short at the bedside.

Betty Jo:
Let's just disrupt that whole model thinking, and a look at what I like to call the Uberization of nursing. But to do that, we can't have the traditional labor model or pyramid that we've had in the past. And that's what trips us up. We start to think about it in a certain way, Dan, but we get tripped up by all the signals in the environment that tell us to do it the traditional way. And so we've got to throw out the entire thing and re-design from the vision and strategy. And then start re-working that strategy and tactic to be able to back into it.

Dan:
I think, when I mention the Uberization of nurses, I get like a visible reaction from some people that have been around for a while. And they're like, oh no, we can't do that. Nurses aren't a commodity. And I think we're not thinking of it as nurses as a random car that's near to me that will pick me up. It's more nuanced than that. It's how do you assess the skills, knowledge, and passions of the nurse, and then use that to match them to the right patient at the right time at the right place? [crosstalk 00:15:52].

Dan:
And I think the more we can get into assessing nurses skills and competencies, rather than these like yearly poster board, annual skills days, or whatever. Like we actually dig in and assess your knowledge. We have a catalog of that. Then we can take that information and match you to the best patient, so you're happy because your skills are being used. And you're not just put on the floor hoping that the patient population that day meets the skillset that you have.

Dan:
And so I think the more we can do that, the better we can then match these skills to patients and actually deliver the care more effectively. And I think that's nursing's kind of golden moment would be when we can do that in a meaningful way at scale. Then we can leverage the 4 million nurses across the country much better than random 12 hour shifts on units.

Betty Jo:
Spot on. I'm starting to say, in big circles, even at like our board level, at the system level, I'm starting to ask the question do we really have a nursing shortage necessarily? Or have we failed to define the role of the nurse and demand matching closer to the time that we needed into the model that we're going to allow nurses to practice it.

Betty Jo:
And so we do have a shortage, but we've made it worse by continuing down the same path with the model that we've chosen. You're 100% spot on. And the nurses are telling us, based on the pandemic, that they want to do new and different things everyday. They don't want to show up. They're not a med surg nurse. They may have med-surg skills and talents, which may be the basis for spring boarding and either learning or leveraging their experience in other areas.

Betty Jo:
Why does a nurse have to be a med-surg nurse every day? Can they not, if they have experience or are willing to get experience, be able to flex up to a telemetry nurse, even an OR nurse? There's no reason why they have to get in to that model other than that's the system we have set to accept that, right?

Dan:
Right. Yeah, I was speaking at the American Association of Colleges of Nursing, at their big, big kind of, they called it their disrupt conference. And I brought it up that nursing is at this Netflix moment. We can go the way of Blockbuster and double down on the way we've always done it. Or we can take our cues from what's been happening, all the breaks in the system, and jump and create the future and build the future of the profession.

Dan:
I think you summed it up there. We have to think differently about this. And it's no longer this having rows and rows of movies available and late fees. It's about thinking of our workforce as individual skillsets that can be leveraged across multiple parts of the system. And really creating that system viewpoint for the nursing workforce and profession. The more we can do that, I think that'll evolve us into a future that's relevant.

Dan:
And if we don't, every other profession is working on enhancing scope of practice, in getting into new care settings. And I think nursing thinks it's invincible, but I think if we don't adapt, we can definitely, as a whole profession, kind of go away.

Betty Jo:
Or somebody is going to redesign it for us, right? I mean, nursing could... And I think your point is never go completely away, but it may go away the way it is today. I mean, when you look at what nurses did during the pandemic, they flocked to agency. Now they went there because there was flexibility, right? They got a taste of flexibility at the highest level by going to an agency. Even those that maybe would not have disrupted their lives to become uncomfortable to travel decided then was the right time to go after their flexibility.

Betty Jo:
I can't see our entire nursing workforce that was there before wanting to settle back down into that normal model. I just don't see it happening now that they have a taste of what it might be like to do this. So, is the whole country just going to go to an agency model? I would say that's probably the most amount of disruption. If we can't figure out how to reorganize and become innovative, to be able to help nurses do what they want to do, I think that we're going to be forced to operate in a model that we didn't design. And I don't think that's going to be the best thing for patient care either.

Dan:
No, I agree. I agree. I mean, there's definitely organizations out there, not big health systems, but companies that have tried to figure out the gig model, where it really is just putting warm bodies into places. And I think that's what we want to avoid. It's not about just having a random RN show up in a place they have no orientation to, no loyalty to, no understanding of the culture, and just show up and work.

Dan:
That's going to be detrimental to patient care and there's evidence around consistency of work. So it is that balance of how do you have a flexible workforce that understands, appreciates, and is embedded and bought into an organization's mission and culture, and has the flexibility to do the things that they want to do professionally and personally. And that's, I think the secret sauce that it sounds like you're working on.

Betty Jo:
I'm working very hard at it right now. In fact, I'm spending the majority of my thinking time, my innovation time on thinking about it in that way to make sure that the health system and Mercy is ready to accept it. There's that external, innovative thinking. And then there is the how do you integrate it into the culture that you've created and gain acceptance? Because when you change the nursing model so drastically you're touching the lives, not only of the patients, but of the providers, all the ancillary staff.

Betty Jo:
And so there's a large amount of work that has to go into preparing the health system to be able to, even if you design the very best model, accepting that very best model. It's a lot of work, and I think that's why some nursing leaders struggle with what does this design look like. Because it is flying in the face of everything that we know to be true today. And it's about moving the whole health system that way.

Dan:
What I've seen some nurse leaders do is go back to what they know. And so they'll call up the old friend and say, hey, what's worked in the past? And I think we're in a situation, in multiple ways, where that doesn't matter anymore. What worked before isn't going to work now. And so I think spending your time on the disruption in the future, where there may not be evidence or answers yet, but really kind of figure out that piece of it is really where I think nurse leaders need to spend most of their time right now.

Betty Jo:
And what I'll say to that is I'm not doing it by myself. I'm not smart enough probably, 100%, to be able to figure this out myself. But what I am looking for are partners out in the industry that have pieces already down that I can leverage to get there faster. Because if I had to redesign this from my nursing perspective all by myself, it would take me too long. But I am reaching out to partners that might understand that gig strategy. So I think that's the basis of it, Dan.

Dan:
Yeah.

Betty Jo:
And you talked about it, but it's about what really is a gig strategy. I've seen people, during the pandemic, call a gig strategy, just paying nurses more to do the same thing. That is, in my mind, not the way this is all going to end up if it's going to be successful.

Betty Jo:
It's about defining what a gig nurse workforce looks like. And then how do you design the platform and the things you need to be able to account for the talent that nurses have, keeping up with the certifications, understanding the quality measures. I even see nurses, as they become more transportable, taking the quality measures with them, underneath their name, right? Like we do providers almost.

Betty Jo:
It's almost a total transformation of the way nursing is looked at today, in the practice lane, and for certain, the operations lane. We've got to get that straightened out first, right?

Dan:
Yeah.

Betty Jo:
So it's going to be interesting, Dan. And the partnership and the collaboration is going to be key. Which is why I was so excited to talk to you today because I feed off of your energy and thinking out in the industry to help fuel the internal thinking of where we're trying to get here at Mercy.

Dan:
No, I love it. I think we definitely feed off each other. And I know there's a lot of fun conversations in our future. As we look towards the first part of this year, what are you excited about, and what are some of the near-term things that you're just jazzed on?

Betty Jo:
I'm very excited about matching patient demand and nurse supply. And while that's a simple business principle, there are so many things that go into that. But we're starting to marry up a couple of concepts. And I think it's important to talk about the concepts that go into this, because it dictates the direction of our thinking and movement.

Betty Jo:
It's about taking quality outcomes into consideration. It's about patient experience, which most people don't talk about. But when you look at the literature, Dan, there's no way to accomplish a true, great patient experience without having that frontline co-worker or nurse engagement score being right along with it. That has to come first. So it's about focusing on what that nurse engagement looks like, but then quickly shifting over to patient experience.

Betty Jo:
And so it's about matching that patient and nurse experience up a little closer than we have in the past. And not designing, for me, the strategies differently on how we address moving that mark, but designing them together. And a piece of it is that gig workforce combined with the hub strategy. That's where the points meet. So it's about optimizing that hub strategy that we talked about before, that patient demand, married up with the nurse staffing piece and then the patient experience piece. It's about how do you look at that and mix that at that hub level?

Dan:
Yeah. I love it.

Betty Jo:
So that's what I'm most excited about.

Dan:
That's right on. And I think, yeah, the workforce piece is going to be the biggest disruption. It has been the biggest disruption, so I love that that's the focus.

Dan:
So as we wrap up the podcast, we like to hand off that one nugget of information to the audience, that one piece that they can take and maybe action on tomorrow. So what would you like to hand off to our listeners?

Betty Jo:
Think about what you're trying to accomplish in your current position, and the vision and strategy behind your nurse leader framework. It really does matter. It's not an academic pursuit to have that framework shored up in your mind. It is 100% essential that you have the lane straightened out that you're operating in before you decide to take on innovation.

Betty Jo:
And the one thing that I want to leave the nurse leaders that are listening to this is, don't be afraid to dig into analytics and technology to help you get there faster. You won't get there without it, but designing it into your strategy is going to be key. And get the help you need to do that. If you personally don't have that thinking, go out and find that thinking. And be able to take your nursing leadership, vision and strategy framework to fruition through connecting it through the data analytics and the technology. And you're going to need some help. But I only know that because I've been on this journey for about two years and I get help every single day, dude.

Dan:
I love it. So have evidence-based leadership framework augmented and enabled by technology and you'll have the perfect platform to change the world, right?

Betty Jo:
Yeah, yeah. And surround yourself with people that don't have the same skill set as you, right?

Dan:
Yeah.

Betty Jo:
[inaudible 00:27:14] Nurses become very valuable sometimes in this space. And as nurse leaders, sometimes we surround ourselves with other nurse leaders, which is essentially important. But bring into your leadership team people that can help you. I have a technology arm and a data analytics arm that's led by a non-nurse. Because, granted, this is not my swing space.

Dan:
Yeah. It's all about the partnership and not being afraid to talk about and expose your gaps and fill that in with people who have it and then make an awesome team work. Betty Jo, loved the conversation today. Thanks so much for being on the show. Where can listeners find more about you? Where do you live online if they wanted to reach out and get more information?

Betty Jo:
Yes, I am certainly on LinkedIn. You can search on my name. I also have a Twitter account that's underneath my name at Betty Jo [Roccio 00:28:02]. And I'm moving into Instagram as we speak as I'm trying to become more innovative, Dan. So soon to come on Instagram.

Dan:
Soon to come on Instagram, TikTok and everywhere else you could find.

Betty Jo:
Right. No, maybe not TikTok, Dan. I'm not that innovative yet.

Dan:
I love it. Betty. Jo, thanks so much. Appreciate it. Listeners, this whole season is going to be about the future of healthcare. And we got a taste of it from a chief nurse executive. Betty Jo, it was awesome. And we'll look forward to chatting with you soon to disrupt and change the world.

Betty Jo:
Thanks Dan.

Thank you and welcome to the Trusted Community!
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